GLP-1受体激动剂在神经保护方面的研究进展
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1.河北医科大学研究生院;2.河北省人民医院神经内科

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科技创新2030-“脑科学与类脑研究”重大项目(2021ZD201807)


Research Development in the Mechanism of Neuroprotective Effects of GLP-1 Receptor Agonists
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    摘要:

    近年来的研究发现,与糖尿病并发的多种神经疾病可随治疗糖尿病的胰高血糖素样肽受体激动剂(glucagon-like peptide-1 receptor agonists, GLP-1RA)的使用而改善,但其具体机制尚不完全清楚。天然的GLP-1是进食诱导刺激回肠和结肠的L细胞分泌的肠肽类激素,其可促进胰岛素的合成和分泌。为克服GLP-1半衰期短而开发的多种长效GLP-1RA已经在临床上广泛应用,如艾塞那肽、利拉鲁肽、阿必鲁肽、度拉糖肽等,这些药物表现出在控制血糖水平和体重上的优势。由于GLP-1受体广泛分布于胰腺、肺、脑、心脏、肾和胃肠等组织细胞膜上,因此GLP-1RA的作用不仅仅在治疗糖尿病方面。已有的报道表明,GLP-1RA还具有显著的神经、心血管、肾脏保护,以及抗呼吸道炎症和减脂等多种作用。GLP-1受体在脑中亦有广泛分布,且GLP-1RA可有效通过脑血管屏障。GLP-1RA与相应受体结合,可激活PKA、PI3K/AKT、ERK、MEK等多个激酶信号通路,调节神经递质传递,这可能是GLP-1RA实现抗炎、减少氧化应激、抑制凋亡、减少DNA损伤、神经细胞修复,最终达到神经保护的途径。本文结合基础及临床研究,拟对GLP-1RA在缺血性脑卒中、认知功能障碍、帕金森病等多种神经疾病中神经保护方面的研究进展进行综述,以期总结其作用机制,并讨论其作为神经保护药物的可能性。

    Abstract:

    Diabetes is now one of the most common chronic diseases in China, and incidences of diabetes in youth have been on the increase. Complications resulting from long-term poorly controlled diabetes can affect many organs throughout the body, including the nervous system. Recent studies have found that various neurological diseases complicated with diabetes can be improved with the use of glucagon-like peptide-1 receptor agonists (GLP-1RA) for the treatment of diabetes, but the exact mechanism is not fully understood. GLP-1 receptor is a transmembrane G protein-coupled receptor found in pancreatic cells and vascular endothelium. Natural GLP-1 is an intestinal peptide-like hormone secreted by feeding-induced stimulation of L cells in the ileum and colon, and it promotes insulin synthesis and secretion. A variety of long-acting GLP-1RA developed to overcome the short half-life of GLP-1 have been widely used in clinical practice, such as exenatide, liraglutide, albiglutide, and dulaglutide, which have shown advantages in controlling blood glucose levels and body weight. Since of GLP-1 receptors are widely distributed on the cell membranes of tissues such as the pancreas, lung, brain, heart, kidney and gastrointestinal tract, GLP-1RA may have a wider application other than the treatment of diabetes. Existing reports have shown that GLP-1RA also has significant function in neurological, cardiovascular, and renal protective effects, as well as other effects such as anti-respiratory inflammation and fat reduction. GLP-1 receptors are also widely distributed in the brain, and GLP-1 and its analogs can cross the blood-brain barrier, thus affecting central nervous system function. This paper analyzed the possible mechanisms of GLP-1RA neuroprotection in various neurological diseases such as ischemic stroke, cognitive dysfunction, and Parkinson's disease and other neurological diseases. When GLP-1RA is applied to ischemic stroke disease, previous studies have found that GLP-1RA binds to the corresponding receptors to activate multiple kinase signaling pathways such as PKA, PI3K/AKT, ERK, MEK, etc., to regulate neurotransmitter transmission and achieve results such as anti-inflammation, reduction of oxidative stress, inhibition of apoptosis, and reduction of DNA damage. In terms of cognitive disorders, many literatures have confirmed that the improvement of cognition by GLP-1RA may be related to its modulation of neurotransmitter transmission in brain domains associated with cognitive function, and subsequently promotes neuroprotection through various pathophysiological mechanisms such as anti-inflammation, anti-apoptosis, autophagy, modulation of insulin signaling pathways, reduction of cytotoxicity, and reduction of aggregation and deposition of β-amyloid and Tau proteins. In the context of Parkinson's disease, GPL-1RA has turned out to have the function of protect motor activity and dopaminergic neurons in animal models of Parkinson's disease. GPL-1RA can also be used to reduce oxidative stress, inflammation, reduce dopaminergic neuron loss, promote growth factor expression, and also improve tyrosine hydroxylase expression in experimental animals. Previous researches on GPL-1RA are not only limited to basic experiments, clinical studies have also demonstrated its therapeutic efficacy in a variety of neurological diseases. Therefore, this article will describe the research progress of GLP-1 receptor agonists in neuroprotection in various neurological diseases such as cerebral infarction, cognitive dysfunction, and Parkinson's disease, in order to summarize their mechanism of action and discuss their potential as neuroprotective drugs.

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  • 收稿日期:2021-11-11
  • 最后修改日期:2022-10-23
  • 录用日期:2022-12-08
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